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내시경적 큰풍선확장술을 이용한 어려운 담관 결석 추출 시풍선확장시간에 대한 비교 연구
이승익 ( Seung Ik Lee ),장승준 ( Seung Jun Jang ),한송이 ( Song Yi Han ),박평화 ( Pyung Hwa Park ),이연희 ( Yeon Hee Lee ),장필규 ( Pil Kyu Jang ),김주현 ( Ju Hyeon Kim ),조재희 ( Jae Hee Cho ),김연석 ( Yeon Suk Kim ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.4
Background/Aims: The ballooning time in endoscopic papillary large balloon dilation (EPLBD) remains controversial. The aim of this study was to evaluate the significance of the ballooning time comparing an immediate balloon deflation method with a conventional ballooning time of > 45 seconds. Methods: Between January 2010 and December 2010, 126 patients with bile duct stones treated with EPLBD and endoscopic sphincterotomy were divided according to the ballooning time: the immediate deflation group (n=56) and the conventional inflation group (ballooning time 45s to < 60s) (n=70). Results: The overall success rate and the success rate of the first attempt of ERCP (endoscopic retrograde cholangio-pancreatography) were 96.4% (54/56) and 80.4% (45/56) in the immediate group and 97.1% (68/70) and 77.1% (54/70) in the conventional inflation group. There were no statistically significant differences in the overall success and the first attempt of ERCP success rate (p=0.99, p=0.66). The frequency of mechanical lithotripsy was 0% in the immediate deflation group and 7.1% in the conventional inflation group (p=0.065). Complications occurred in 3.6% (2/56) patients in the immediate deflation group and 8.6% (4/70) patients in the conventional inflation group (p=0.298). Conclusions: The ballooning time in EPLBD does not affect the outcomes of the treatment for bile duct stones. And the feasibility of the immediate deflation method in EPLBD is acceptable. Korean J Pancreatobiliary 2014;19(4):182-188
췌장 점액성 낭성 종양과 감별이 어려웠던 췌장내 부비장의 유표피 낭종
박평화 ( Pyung Hwa Park ),조재희 ( Jae Hee Cho ),장필규 ( Pil Kyu Jang ),한정윤 ( Jung Yoon Han ),이승익 ( Seung Ik Lee ),김연석 ( Yeon Suk Kim ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.3
An epidermoid cyst arising from intrapancreatic accessory spleen (ECIPAS) is a rare disease. Most patients with an ECIPAS are detected incidentally and could be misdiagnosed as a pancreatic cystic neoplasm such as mucinous cystic neoplasm (MCN) or intraductal p ancreatic mucinous neoplasm (IPMN). We described an ECIPAS with high cystic fluid carcinoembryonic antigen (CEA), which was misdiagnosed as a MCN of pancreas. Fifty one-year-old female was presented with a 2 cm sized nonenhancing pancreas cystic mass on the outside CT scan. Endoscpic ultrasonography (EUS) guided aspiration was performed. It showed a 2.3 × 1.9 cm unilocular cyst nearby 1.6 × 1.1 cm homogenous hypoechoic mass in pancreas tail, and cystic fluid CEA was 1564.18 ng/mL. On the basis of EUS results with elevated fluid CEA level, the presumptive diagnosis is likely to MCN of pancreas, and she underwent a laparoscopic distal pancreatectomy. The final pathology was the epidermal cyst in the intrapancreatic accessory spleen.
원인 미상 간세포암이 갖는 비알코올 지방간의 임상적 특징
임민영 ( Min Young Rim ),권오상 ( Oh Sang Kwon ),하민수 ( Minsu Ha ),김주승 ( Ju Seung Kim ),고광일 ( Kwang Il Ko ),김동규 ( Dong Kyu Kim ),장필규 ( Pil Kyu Jang ),한정윤 ( Jung Yoon Han ),박평화 ( Pyung Hwa Park ),정영걸 ( Young 대한소화기학회 2014 대한소화기학회지 Vol.63 No.5
Background/Aims: Nonalcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). The aim of this study was to evaluate whether patients with cryptogenic HCC share clinical features similar to that of NAFLD. Methods: Cryptogenic HCC was defined as HCC that occurs in patients with the following conditions: HBsAg(-), anti-HCV(-), and alcohol ingestion of less than 20 g/day. All patients diagnosed with cryptogenic HCC from 2005 to 2012 (cryptogenic HCC group), and all patients diagnosed with HBV associated HCC between 2008 and 2012 (HBV-HCC group) were enrolled in the present study. Clinical features, BMI, lipid profiles, presence of diabetes mellitus, hypertension, and metabolic syndrome were compared between the two groups. Results: Cryptogenic HCC group was composed of 35 patients (19 males and 16 females) with a mean age of 70±11 years. HBV-HCC group was composed of 406 patients (318 males and 88 females) with a mean age of 56±7 years. Patients in the cryptogenic HCC group were older (p=0.001) and female dominant (p=0.042) than those in the HBV-HCC group. There were no differences in the laboratory test results including lipid profiles and Child-Turcotte-Pugh class between the two groups. Patients in the cryptogenic HCC group had higher prevalence of diabetes (37% vs. 17%, p=0.015), hypertension (49% vs. 27%, p=0.051), metabolic syndrome (37% vs. 16%, p=0.001), and higher BMI (25.3 kg/m2 vs. 24.1 kg/m2, p=0.042) than those in the HBV- HCC group. The tumor stage was more advanced (stage III and IV) at diagnosis in the cryptogenic HCC group than in the HBV-HCC group (60% vs. 37%, p=0.007). Conclusions: Cryptogenic HCC has clinical features similar to that of NAFLD and is diagnosed at a more advanced tumor stage.